Everything In Moderation
“The authorities (often self appointed ) who argue for moderation in our eating habits tend to be those who are relatively lean and healthy. They define moderation as what works for them”
- Gary Taubes
The Western diet causes Western diseases. Diabetes, obesity, hypertension, cardiac disease, and all the inflammatory diseases that result in chronic illness including many orthopedic ailments. Cardiac disease and diabetes alone affect half of Americans and account for 85% of healthcare costs. The Western diet has many different definitions, but at its core it includes a lot of processed carbohydrates, refined sugars, dairy products and processed meats. Contrarily, a healthier diet includes plants, nuts, and non-processed meats. Our ancestors only ate plants, nuts and meats. Native and aboriginal people lived this way in the 1800s and 1900s and a few tribes still live this way today. It is no coincidence that the diseases of the modern world did not exist in these cultures. As native tribes’ lands were colonized, or where they came into contact with the Western world they quickly became obese, diabetic and eventually suffered from all the diseases of the Western world. Now we know that eating the Westernized or Standard American Diet has a lot of drawbacks, and currently the world is full of experts who will argue one healthy diet over another. In reality, they all have benefits and can improve health because they cut back on sugar and processed foods. However, our culture has grown accustomed to certain “pleasure” foods that we do not seem willing to give up completely. As a result many health experts recommend eating “everything in moderation”. Some even break this down into eating healthy 80-90% of the time and eat whatever you want 10-20% of the time. Unfortunately, this is easier said than done. Each individual has different DNA and genetic makeup. Therefore, what may be healthy for one person may not be for another, and what is a treat for one person may be dangerous for another. Everyone is on a different health journey and each journey is slightly easier with some support. So if someone is overhauling their nutrition, lecturing them about eating “everything in moderation” may not be so helpful.
Now let’s think about smoking as a parallel to nutrition. We understand the relationship between smoking and lung cancer. Many people smoke and never get cancer just like many people eat a Standard American Diet and never develop related health issues. But, do we tell people to only smoke in moderation? Smoking is obviously enjoyable or smokers would not do it. Do we feel like we are depriving ourselves if we do not smoke? Do we feel like our kids are deprived if we do not let them smoke? Of course not. Most people who do not smoke do not even think about it and we all know lots of people who do not smoke. There are also many people who eat healthy. They do not miss unhealthy food. They do not feel sorry for themselves. They do not think their kids had a horrible childhood because they were not hooked on sugar, soda, fast foods and chips. Somehow many of us (myself included) have been brainwashed that it is OK to eat the standard American diet as long as we eat it in moderation.
But what is moderation? How much fast food is OK? How much sugar or processed carbohydrates are OK? How many nutrition related health problems are you willing to tolerate? We know that food is making us sicker. We also know that moderation is just something we made up when it comes to unhealthy foods because we still want to eat them. How much we can tolerate varies from individual to individual. This is easy to see in cases of obesity because it can be an apparent visual indicator of diet. Other diseases are hidden. I can not tell your blood pressure, inflammation level or glucose level by just looking at you. But, in my experience, I have seen many of my patients that are literally falling apart. Joints that can no longer hold up. Injections, medications and surgeries add up year after year. I often see people at the end of the road. Certainly, some ailments are unavoidable or unavoidable with our current medical knowledge. Others are stuck in a “wish we knew then what we know now” situation. By this, I mean that these patients did not have the necessary nutrition and health information when they were younger that we have now. The vast majority of us can build nutritional habits to drastically improve our future health.
My nutritional opinions are formed by a few things. I grew up eating peanut butter sandwiches every day. Plantar’s peanuts or a spoonful of JIF were a common snack. A life without peanuts seemed impossible. When I became a parent, my oldest son was diagnosed with a severe peanut allergy as an infant. His instructions are simple: “If you eat peanuts there is a strong possibility you will die”. The doctors were straightforward, clear, and simple with their message. He has chosen not to eat peanuts.
I think this type of thinking should also apply to sugar. Some people can not tolerate much sugar. By sugar I do not mean just sweets and treats. Processed carbs such as breads, rice, pasta, and even healthy grains are quickly turned into sugar by your body. Many people have success with moderation diets limiting these foods. Others, however, are headed to obesity or diabetes if they eat these foods. Instead of physicians saying “if you eat these foods there is a strong chance you will be disabled or even die sooner than you’d like”, they are often more vague. They ask people to improve their diet and start pharmaceutical treatment. This path works for some, but many would prefer a complete diet overhaul if they were fully informed about the potential of their future health. Just like my son can not eat peanuts, others can not tolerate sugar without significant damage to their health. It is my belief that as physicians we should be blunt. However, this is hard to do (read my blog “ Medicine and Health” for a look at some of the challenges physicians face). Let people know a complete nutrition overhaul is best and work back from there to a plan the patient is willing to try. The plan may be one that depends 100% on pharmaceuticals, but at least the patient is making an informed choice.
Unfortunately, when attempting to make an informed choice it is often difficult to trust nutritional science. This is because it is relatively easy to design studies to support a target diet by manipulating who is included in the study and cofactors. An example would be the studies funded by the sugar industry to avoid placing any blame on sugar for the obesity crisis. These studies set out to blame fat and lack of exercise for our increasing waistline. Unfortunately, for a whole generation we replaced foods that contain healthy fats for sugar and processed carbohydrates. Sometimes the error may not be intentional. An example was when I was growing up I was told to limit eggs. The plaques that clog coronary arteries and cause heart disease have cholesterol in them, eggs have cholesterol in them, so do not eat eggs. This message was amplified by the cereal makers to increase profits. So, I replaced eggs with cereal and pop tarts and washed them down with milk and orange juice. We now know the cholesterol and fat in eggs are healthy and do not lead to coronary plaques or blockages. My parents were trying to feed me the best they could. It was not their intention to send me off to school on a sugar high heading for a mid morning crash.
As unreliable as nutritional science can be, the media makes it even worse. They often jump on a study and amplify its result without looking deeper. It is important to look for bias in any study including who funded it and search for any hidden agenda. A study funded by the dairy industry is likely to omit that you can build strong bones without drinking daily milk. It will not mention that some people have lactose intolerance and another group has increased congestion and skin issues due to dairy intake. It is common that the media will only report part of the story. There are examples of this occurring in pro-vegan documentaries. They love to show cruel factory farming of chickens and beef without showing healthier meat sources such as grass fed beef and free range chickens exist. They will often compare vegans to non-vegans by comparing vegans to people who eat the standard American Diet instead of comparing vegans to people who eat lean meats and vegetables. When you finally find someone who promotes what appears to be a great way to eat, they often become popular and start promoting their brand. It makes you wonder if they have become too biased and ingrained in their brand to evaluate new information as it comes in. So in the confusing world where it is hard to find reliable sources, what can someone do?
The first video is a quick summary of the book Blue Zones. This is a great book about the diets and lifestyles of people in areas of the world where many inhabitants live to be 100 years old. These people tend to eat a lot of plants according to the author, Dan Buettner. The second video is by orthopedic surgeon and carnivore advocate, Shawn Baker, M.D. He discusses with nutritionist, Mary Ruddick, that over the course of a year these cultures eat a significant amount of meat and fish as well. If you do a deep dive on the internet you can see the two sides criticize each other's interpretations of the real blue zone diet. I not this as a current example of the two sides of the nutrition debate presenting confusing information instead of starting out agreeing that it is clear blue zones are not living on sugar, processed carbs, and junk food that are the key ingredients of the standard American diet.
You need to find out what works for you. Start with vegetables. In general, vegetables are great. They are filled with nutrients and are a healthier alternative to processed carbohydrates. The problem is some people have food sensitivity to certain vegetables. An example is my recovered vegan wife who can not eat broccoli. Food sensitivity can involve gastrointestinal irritation, bloating, fatigue, joint pain, and even skin rashes. With time, most people can figure out if a certain vegetable upsets their stomach, but it is harder to determine if they contribute to joint pain. Food sensitivity testing can help, but it is not completely accurate. My son tested sensitive to kale and spinach and his bloating improved once he eliminated them. He was lucky to find out this sensitivity. Since the accuracy of these tests is questionable the only way to truly determine sensitivity is an elimination diet. This means you eliminate the majority of foods and add them back one food at a time. Obviously, quite a task but necessary for some. Also remember our ancestors did not have the wide array of vegetables available to them that we can find in the supermarket. In reality, both ancient and modern day hunter gatherer cultures mostly hunted. Vegetables are seasonal and difficult to store for the winter months. It can also be a challenge to get enough protein. Protein is necessary to maintain muscle and maintaining muscle is critical as we age. Beans are often used as a vegan protein source but some people just can not tolerate them.
Now move on to fruits and honey. Fruits and honey are delicious and a great alternative to processed sweets and snacks. The problem is some people can not eat beyond a minimal amount of fruits or honey without becoming overweight or prediabetic. Others have the same issues of food sensitivity to their gut, joints, and skin that I discussed with vegetables. Again, primitive cultures did not eat much fruit. Simply because fruit has a short growing season and other animals often got to the fruit before humans did. So fruit is great if you can tolerate it.
Then comes maybe the most controversial food group - meat. Beef and water are the only foods you can survive on alone without supplements or any other food groups. We are mammals and many mammals can survive on meat alone. This is the reason for the surge of interest in the carnivore diet. Many of the diet's greatest advocates struggled with diseases of chronic inflammation that were cured by eliminating everything but meat. It turns out that all the minerals, and vitamins you get from other food groups are in meat. Apparently you do not need all the fiber if you are only eating meat. It is said that desperate times call for desperate measures. Some people are desperate enough with diseases of chronic inflammation that they will jump on the carnivore bandwagon, but it is not easy to eliminate all other foods. Others will use it as an elimination diet. This means they will try it for 30-90 days, enough time for all potential food sensitivities to leave their body and then add back one food at a time. It is hard work but can be a cure for many. Obviously, there are plenty of personal reasons someone may not eat meat that range from ethical reasons to simply not liking the taste or texture. Regardless, it is a personal decision. Just be aware if you choose not to eat meat, do not replace it with processed carbs and sugar but with vegetables. Vegan or vegetarian means vegetable eaters, not someone who eats an abundance of processed carbs. If you replace quality meats with processed carbohydrates and grains you are not doing your health any favors. Many are concerned, including some physicians, about how a diet heavy in meat consumption could affect a patient's cholesterol and lipid profile. The majority of the body’s cholesterol comes from their own liver and not their diet. As a result many carnivores have no change in their lipid profile. Some can have an elevation in cholesterol and lipids and ultimately they need to decide whether they will quit the diet, treat the cholesterol change with medication, or live with the elevated lab results. Many carnivore advocates choose to live with the higher lab results and claim no adverse effects. Opponents of the carnivore diet remain skeptical this could be detrimental to vascular health in the long run. Once again it is difficult to analyze the claims on both sides due to bias. My opinion is we need way more research on long term carnivores. For a short term elimination diet it could have real benefits without much concern for increased lipid levels. If you choose to do your own research on meat consumption, which I encourage, be aware there is a lot of controversy regarding the meat industry's effect on the environment and thus research bias.
*The speaker is an example of desperate times calling for desperate measures. She used the carnivore diet to cure her autoimmune disease. It is anecdotal evidence but she encourages more research into the topic.
Another low carbohydrate diet is the Paleo Diet. This diet basically is an ancestral diet. If it was available to a caveman you can eat it. A true ancestral diet can not be copied because both our plants and meats have been modified over countless generations. Many advocates have great success with this diet. You need to avoid food sensitivities to find joint pain and gut issue relief. To optimize the diet, you would focus on vegetables and healthy lean meats. The issue I have seen some people run into is they start the diet because they saw someone else have great results, but they immediately start looking for paleo compliant or grain/gluten free junk food. Many of these people are excited to find paleo bread, cookies, pasta, or pancakes. These are all foods with limited nutritional value. If you are going to enjoy a treat you should just enjoy the real deal unless you have a real allergy or sensitivity to grains or gluten. If you are trying to lose weight do not replace empty junk food calories with paleo junk food. Stay with nutritious plants and meats for success.
As a society, the vast majority of us are addicted to sugar or processed carbs. No matter what nutrition plan you choose, you should limit sugar and processed carbs. Whether you become a vegan, a vegetarian, a carnivore, or something in between you will likely go through a few days to a few weeks of sugar and carbohydrate withdrawal. Do not confuse this with the diet not working for you. Once you get through the sugar withdrawal you will notice your cravings diminish greatly. You may still physiologically crave food meaning something might sound good but your physical cravings will greatly diminish. Without physical cravings it is easier to shorten your eating window or go without food. Intermittent fasting has been shown to have some great health benefits. This means going 16 hours a day without food but allowing water, black coffee, or tea. Some will fast for 24 hours or even several days for a more prolonged fast. It sounds hard but it is actually pretty easy to go 16 hours if you're not addicted to sugar. It is really just skipping breakfast. As far as weight loss, many of these diets are helpful. The simple reason is they all tend to decrease daily calories. Once you overcome the sugar and carbohydrate withdrawal you will likely eat less calories. If you eat less calories you will lose weight in the long run.
I would like to point out many of these diets can be used short term as a reset. For instance some people struggle with eating vegetables so being a vegetarian or vegan for a couple months could help you learn to prepare and enjoy more plant based food. If you're trying to learn to limit your sugar and processed carbohydrates, going hardcore paleo could be useful with a goal of a well defined 90/10 or 80/20 down the road. If you struggle with food sensitivities using the carnivore diet as an elimination diet and adding back plant foods gradually and observing how your body reacts could be life changing. Intermittent fasting could be used in the short term to prove to yourself you can survive skipping meals. If the choice is between junk food or nothing you can survive choosing nothing for a couple hours until a healthy option is available.
Several times I have brought up ancestral diets or the diets of native people. Most historical records note how physically and mentally healthy tribal people are and that they do not suffer from western diseases. I will also hear distractors comment that these people have a significantly decreased lifespan compared to us. That is actually not true. Modern medicine with excellent trauma care, obstetric care, and infection care has improved our lifespan. Our ancestors were far more likely to die from infections, childbirth, and trauma than us. If you eliminate these causes of premature death they likely lived long and healthier lives.
So what is the perfect diet? The point of the preceding paragraphs is it is different for everyone. Ideally most people can eat a plate of mostly vegetables with some lean meats. Some people can eat a lot of fruit but others need to be careful. People can tolerate varying amounts of healthy grains or dairy. If you are not allergic or sensitive you can eat nuts. Many people need to cut back or completely eliminate certain foods due to sensitivities. There is no” everything in moderation diet". The ”everything in moderation diet” is what works for you.
In general setting a goal of 90/10 or 80/20 is great but you may need to be more specific. The reason is general rules are often hard to keep whereas specific rules may be easier. Limiting yourself to one daily snack that is less than 10-20% of your daily calories, or limiting to a few cheat meals a week that are less than 10-20% of your weekly meals, or even eating whatever you want socially or around holidays as long as it adds up to less than 10-20% of your yearly meals could be better options. Specific rules can guard against the greatest challenge for many when it comes to healthy eating- Emotional eating
This is a great video which reviews some common causes for emotional eating. In considering eating habits and nutrition, an important thing to be aware of is that we eat from boredom. Think of when you are studying or at work and you grab a snack to break up the monotony. Really you just need to get up and move around but you grab a snack to give your moving around a purpose. We all have a tendency to associate food with joy. We get excited for our favorite dinner, our favorite restaurant, or our favorite treat. Our culture has replaced many of the foods that would have excited our ancestors with unhealthy options. Morning coffee has brought joy to previous generations, but cafes have turned most coffees into desserts. We do not actually love coffee anymore, we love the sugar or artificial sweeteners. Some people eat to relieve stress and others to relieve anger. Many eat to distract them from sadness. We call it comfort food, but it is really just a temporary distraction. We do not give attention to our sleep which makes us hungrier. We feel like we need energy so we eat a sugary sweet for a temporary boost only to crash lower than we were in a few hours. The solution is mindful eating. In other words, pay attention to the “why” every time you eat. Once you notice the ‘why’ then you can think of what could be more fulfilling than eating. If you're hungry choose a satisfying meal. If you're bored, go for a walk, call a friend, read a book, or search for a hobby. If you're stress eating due to anger, anxiety, or sadness you need to address the underlying cause.
You may have heard of people trying to remain present. This is a philosophy where your anxiety is worrying about the future and your depression is worrying about the past. Life occurs in the present. To learn more consider reading The Power of Now by Eckhart Tolle.
A key in life is to enjoy the present while delaying gratification. Unfortunately the wellness and fitness community ask you to use all your will power to perfect your diet so you can look and feel great in the future. I am suggesting instead of looking at a huge weight loss or health goals in the distant future to look at today. What foods are going to help you today? Not the temporary mouth pleasure you get in the moment. What food will relieve hunger, not upset your stomach, and give you sustained energy and no guilt today? That is what you should be eating and it varies for everyone.
Generally, diets have a horrible track record. A person has a tendency to go on a diet and lose weight, but this is often followed by binging and gaining even more weight back. Eating is how many of us cope, but we need to learn better strategies. The video describes how we use food as a painkiller, an escape, and even a punishment. Anyone who has studied Buddhism or just paid attention to life knows that life involves suffering. We use food as a painkiller. The problem is when we eat unhealthy food we increase both our pain in the short term with guilt and in the long term with disease. We use food as an escape from stress and anxiety instead of using healthier tools like exercise, sleep, and stress reduction techniques (go to stress in the lifestyle section of this site for more). Food can be used as a punishment to ourselves too. In college I used to joke that we should eat until it hurts because we don’t know when we can eat again. I try not to do this anymore, but we all have our weaknesses. I still eat until it hurts when I pound chips and queso and the combination enchiladas at my favorite Mexican restaurant. Ok, I do not want to lie. Any Mexican restaurant. Regardless, everyone at some point has likely felt the physical and even emotional pain associated with overeating.
Now, maybe the hardest thing when it comes to emotional eating is you can not quit cold turkey. We all need to eat. Your best option is to address the underlying causes. Your stress not only increases your hunger, but it also causes the body to store fat. Your lack of sleep makes you hungry, makes you store fat, and increases your stress. You need to turn your attention to self care. This means you need to move and exercise. You do this not for the goal of having the perfect body, but to improve your mood and stress level today. You start a stress management program. This can include prayer, meditation, breathwork, journaling or practicing gratitude. This may include working with a therapist or another medical professional. Life is a team game. Support on your health journey is absolutely beneficial.
We are not all in equal situations. Some people have family, friends, and co-workers who have been anxiously waiting for you to show interest in improving your health. Not everyone is this fortunate. Others are surrounded by people who would like to support you, but are not informed with useful information. They may question your decisions with the latest biased information they saw on the internet without taking a deep dive. They may believe what works for them will work for you. This could result in criticizing your approach to support their own. It could also mean they encourage an approach to moderation that does not work for you. This could mean encouraging you to drop your guard when out socially and ‘live a little’ without realizing this could send you down a downward spiral. Some people will be jealous. Misery loves company. Your success and excitement may force them to shine a light on their own habits. The solution is to find mentors. You can find encouragement by reading books, watching videos, joining online groups, following health related social media, and getting to know people who are interested in health and wellness.
“Men do not fail, they quit”
-Anonymous
In conclusion, I believe everyone can improve their health. Some hope to increase their lifespan, but others just want to improve their health span or healthy years. Many will say, “relax, we all die anyway” and of course they are correct, but the goal is to have the best life possible. You could even be a ‘Black Swan’ which I have discussed in a previous blog with that title but at least you could enjoy being healthy and active up to that point. If you know someone who is improving their lifestyle I hope you will give them your full support. If you are improving your lifestyle I wish you the best of luck and hope my blogs and social media can be of some use to you. If you have tried everything and have given up I would ask you to consider this video.
Ali gave this speech when he was about to fight the undefeated heavyweight champion George Foreman. Ali had once been unstoppable destroying the unbeatable Sonny Liston twice in his youth. His age and his exile from boxing took away some of his magnificent skills. Despite this he claims that he is better than he was because he has been knocked down, his jaw has been broken, and he has new training techniques. It is the classic lesson taught in Tao Te Ching. You learn more from your failure than your success. If you have given up living a healthy lifestyle remember you are better than you were. You now know what does not work for you. You have more techniques, knowledge, and support than at any time in the past and new helpful information is coming out rapidly.
“Success is not the absence of failure, it’s the persistence through failure”
- Aisha Tyler
And by the way Ali knocked out Foreman in the 8th round.